A recent report that states the choice between warfarin and aspirin in patients with heart failure and sinus rhythm should be individualized is the most definitive word to date on the topic, says a hospitalist focused on anticoagulation therapies.

“The new thing about this study is it’s really the definitive, well-designed, large trial that provides guidance to us as to what is right,” says Margaret Fang, MD, MPH, an associate professor of medicine at the University of California at San Francisco (UCSF) and medical director of the UCSF Anticoagulation Clinic. “Is warfarin really the right decision?”

Dr. Fang notes that the report, known more commonly as the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial, did find that, over time, warfarin began to show improvement over aspirin. But the improvements, which favored warfarin by the fourth year of the six-year trial, were deemed only marginally significant (P=.046).

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